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  • 11
    ISSN: 1365-2044
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: The Cardiff paediatric laryngoscope blade is a single blade that has been designed for use in children from birth to adolescence. This open, randomised, crossover study compared the Cardiff blade with the straight, size 1, Miller laryngoscope blade in 39 infants under 1 years of age and the curved, size 2, Macintosh blade in 39 children aged 1–16 years. The same laryngoscopic view was obtained with the Cardiff and Miller blades in 26 patients; the view was better with the Cardiff blade in seven patients and better with the Miller blade in six (median (IQR [range]) grade of laryngoscopy 1 (1–2 [1–3]) vs. 1 (1–2 [1–3]), respectively; p = 0.405). The Cardiff blade was faster at gaining a view than the Miller blade (mean (SD) time 8.5 (2.9) s vs. 10.2 (3.5) s, respectively; 95% CI for difference −2.8 to −0.4; p = 0.009). The Cardiff and Macintosh blades produced the same view in 32 patients; the view was better with the Cardiff blade in seven patients (median (IQR [range]) grade of laryngoscopy 1 (1–1 [1–3]) vs. 1 (1–2 [1–3]), respectively; p = 0.008). There was no difference in time to gain these views: mean (SD) 8.7 (3.0) s vs. 9.3 (2.7) s, respectively (95% CI for difference −1.58 to 0.40; p = 0.237). The Cardiff paediatric laryngoscope blade compares favourably with these two established laryngoscope blades in children.
    Materialart: Digitale Medien
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  • 12
    Digitale Medien
    Digitale Medien
    Oxford, UK : Blackwell Science Ltd
    Anaesthesia 59 (2004), S. 0 
    ISSN: 1365-2044
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: Sevoflurane is a non-pungent volatile anaesthetic agent with a low blood-gas solubility coefficient. It has been studied in concentrations of up to 8% for induction of anaesthesia. Previous work has suggested that there may be a ceiling effect with increasing concentration of sevoflurane above 6%, but there are no published studies using 12% sevoflurane. This study compared 8 and 12% sevoflurane to induce anaesthesia in adults. Sevoflurane was administered using two adapted datum vaporisers with the interlock removed. Induction with 12% sevoflurane compared to 8% sevoflurane produced a significant decrease in the time to achieve central pupils, corresponding to surgical anaesthesia and the third part of Guedel's stage 3 of anaesthesia (mean time (SD) 201 s (81) and 247 s (39), respectively, p 〈 0.05). Twelve-percent sevoflurane produced a similar stable cardiovascular profile to 8% sevoflurane, and there was no increase in respiratory complications.
    Materialart: Digitale Medien
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  • 13
    Digitale Medien
    Digitale Medien
    Oxford, UK : Blackwell Science Ltd
    Anaesthesia 57 (2002), S. 0 
    ISSN: 1365-2044
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: Where practicable, exposure to a hazardous substance should be eliminated or adequately controlled. A postal questionnaire survey was sent to 10% of consultants from the Association of Anaesthetists of Great Britain and Ireland, to identify the level of use of nitrous oxide in current anaesthetic practice and identify any change of practice over the last 5 years. Details of anaesthetic practice were requested in three areas: nitrous oxide usage, availability of medical air on anaesthetic machines and the use of total intravenous anaesthesia. Replies were received from 320 consultants (75%). Of these, 49% felt that, over the last 5 years, their use of nitrous oxide had decreased. Twenty per cent of anaesthetists felt that there should be some restriction in availability of nitrous oxide. Where medical air was available, 32% felt that they would use it frequently. A total of 263 (83%) stated that they use total intravenous anaesthesia to some extent. The results showed that, although 49% of consultant anaesthetists had reduced their use of nitrous oxide, this was due to medical considerations rather than concerns over health and pollution issues arising from the use of nitrous oxide.
    Materialart: Digitale Medien
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  • 14
    Digitale Medien
    Digitale Medien
    Oxford, UK : Blackwell Science Ltd
    Anaesthesia 57 (2002), S. 0 
    ISSN: 1365-2044
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: Summary Accidental oesophageal intubation is still an important cause of anaesthetic morbidity and mortality. This study investigated the use of impedance respirometry to determine the position of a tracheal tube. Seventy-nine patients undergoing general anaesthesia requiring tracheal intubation with muscle relaxation were recruited to the study. After pre-oxygenation, tracheal tubes were placed in both the oesophagus and trachea; a breathing system was attached to one tube chosen randomly. A blinded observer was required to correctly identify the position of the tube within six tidal ventilations. The position of every tube connected to the breathing system was correctly identified. The median time to correctly identify tracheal and oesophageal tubes was 3 and 5 s, respectively. The median number of breaths to identify tracheal and oesophageal tubes was two for both groups. Every tube position was identified within the required six breaths. Impedance respirometry is a reliable method for diagnosing tracheal tube position.
    Materialart: Digitale Medien
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  • 15
    ISSN: 1365-2044
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: The effect of two levels of humidification on the incidence of adverse airway events was studied in 58 adult female patients during deepening of anaesthesia using up to 12% desflurane. Humidification was provided by a breathing system filter with either low moisture-conserving performance (17.2 mg.l−1 at 0.5 l tidal volume, Group L) or high moisture-conserving performance (33.5 mg.l−1 at 0.5 l tidal volume, Group H). Forty-eight per cent of patients smoked and there were more smokers in Group L than in Group H. Adverse airway events consisted of coughing and laryngospasm. For coughing, the dominant explanator was smoking. When both humidity and age were included in the analysis, there was a significant smoking–humidity interaction (p 〈 0.05), such that high humidity decreased the incidence of coughing in nonsmokers but not in smokers. The incidence of laryngospasm was significantly lower in Group H than in Group L (p 〈 0.05). We conclude that when patients inspire high concentrations of desflurane during induction of anaesthesia, increasing humidification to the levels achieved in this study decreases the incidence of coughing among nonsmokers and of laryngospasm in both smokers and nonsmokers.
    Materialart: Digitale Medien
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  • 16
    ISSN: 1365-2044
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: Several methods are available to measure splanchnic blood flow and gut ischaemia. Tonometry is most practical for peri-operative use. Epidural blockade from T5 to T11 causes mesenteric arteriovenous vasodilation and may increase splanchnic blood flow. This study assesses the ability of tonometry to measure differential effects of opiate and epidural analgesia on splanchnic blood flow. Forty patients for elective colorectal surgery were randomly allocated to receive epidural infusion or intravenous morphine. Gastric mucosal Pco2, pHi, standard pHi, Pco2 gap and pH gap were measured after induction and on termination of surgery. These parameters were within normal limits at the end in most cases and there was no significant difference between the groups. The complication rate was similar in both groups and was not correlated with low pHi, but was correlated with blood loss. We were unable to demonstrate a difference in splanchnic perfusion, as assessed by gastric tonometry, between the two groups.
    Materialart: Digitale Medien
    Bibliothek Standort Signatur Band/Heft/Jahr Verfügbarkeit
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  • 17
    ISSN: 1365-2044
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: The second stage of anaesthesia was examined during 3 and 8% sevoflurane induction to see if any shortening of its duration was at the expense of cardiovascular stability. Fourteen volunteers underwent consecutive, randomly ordered inductions. Pupil size, skin sympathetic activity, plasma catecholamines, blood pressure and heart rate were measured. Eight per cent sevoflurane produced significantly shorter times to loss of consciousness (mean 68 s (SD 18) vs. mean 150 s (SD38)) and durations of second stage (mean 58 s (SD 38) vs. mean 91 s (SD 46)). Blood pressure, heart rate and sympathetic nerve responses were the same in both groups. Compared with baseline, skin sympathetic activity was greatest during pre-oxygenation (not significant) and unaltered during second stage. Both groups showed significantly increased plasma norepinephrine and heart rate and decreased blood pressure from baseline. Eight per cent sevoflurane induction produced a shorter second stage than 3% with equal cardiovascular stability and the same sympathetic response.
    Materialart: Digitale Medien
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  • 18
    Digitale Medien
    Digitale Medien
    Oxford : Blackwell Science Ltd
    Anaesthesia 55 (2000), S. 0 
    ISSN: 1365-2044
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: Sevoflurane induction of anasthesia has been examined extensively, but little is known about the usefulness of other drugs as adjuncts to hasten and smooth the process. Sixty patients, undergoing surgery of a type suitable for a spontaneous respiration, laryngeal mask airway anasthetic technique, were randomly allocated to receive 1.0 μg.kg−1 intravenous fentanyl or the equivalent volume of normal saline, 30 s prior to triple-breath induction with sevoflurane. The study was double-blind. There were no differences between the groups for the times to loss of eyelash reflex, jaw relaxation, insertion of the laryngeal mask airway or regular settled breathing. However, there was a difference in the incidence of adverse airway events (breath-holding, coughing and laryngospasm) between the two groups (16.5% in the fentanyl group and 40% in the placebo group); this did not reach statistical significance. Both groups were haemodynamically stable throughout induction, although the fentanyl group had a statistically significant decrease in systolic blood pressure at 4 min compared with the placebo group, which was not considered clinically relevant. We conclude that fentanyl has no significant influence over the speed and quality of sevoflurane induction.
    Materialart: Digitale Medien
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  • 19
    Digitale Medien
    Digitale Medien
    Oxford, UK : Blackwell Publishing Ltd
    Water and environment journal 7 (1993), S. 0 
    ISSN: 1747-6593
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Energietechnik
    Notizen: Traditionally, sewage-works design in Hungary has been based on rigid national standards with little consideration being given to the requirements of individual situations. This has resulted in plants that performed poorly and were expensive to construct and operate.The paper describes measures to improve the environment by upgrading Miskolc sewage-treatment works, and the conflict between the cost of those facilities, and the ability to pay against a background of changing economic conditions.
    Materialart: Digitale Medien
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  • 20
    Digitale Medien
    Digitale Medien
    Oxford, UK : Blackwell Publishing Ltd
    Water and environment journal 9 (1995), S. 0 
    ISSN: 1747-6593
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Energietechnik
    Notizen: Sludge production and disposal are entering a period of dramatic change, driven mainly by EC legislation. The urban waste water treatment Directive will result in at least 50% more sludge being produced by the end of 2005 and, during the next decade, sludge disposal to all the established outlets could become increasingly difficult or, in the case of sea disposal, will become illegal. The challenge facing the members of the European Union is how to (a) maintain cost-effective and secure methods of sludge disposal and (b) engender public confidence in all disposal and recycling options. What is required is not so much innovative technology, although this may be essential, but more innovative attitudes and approaches to promotion and defending existing outlets.This paper describes the likely pattern of sludge production, treatment and disposal which will emerge during the implementation of recent EC directives and other national policies in Europe, and focuses on the areas and issues which require innovative approaches.
    Materialart: Digitale Medien
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